title: Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. EDEN trial follow-up.
abstract: BACKGROUND
  We hypothesized that providing patients with acute lung injury two different protein/calorie nutritional strategies in the intensive care unit may affect longer-term physical and cognitive performance.
  
  
  OBJECTIVE
  To assess physical and cognitive performance 6 and 12 months after acute lung injury, and to evaluate the effect of trophic versus full enteral feeding, provided for the first 6 days of mechanical ventilation, on 6-minute-walk distance, cognitive impairment, and secondary outcomes.
  
  
  METHODS
  A prospective, longitudinal ancillary study of the ARDS Network EDEN trial evaluating 174 consecutive survivors from 5 of 12 centers. Blinded assessments of patients' arm anthropometrics, strength, pulmonary function, 6-minute-walk distance, and cognitive status (executive function, language, memory, verbal reasoning/concept formation, and attention) were performed.
  
  
  RESULTS
  At 6 and 12 months, respectively, the mean (SD) percent predicted for 6-minute-walk distance was 64% (22%) and 66% (25%) (P = 0.011 for difference between assessments), and 36 and 25% of survivors had cognitive impairment (P = 0.001). Patients performed below predicted values for secondary physical tests with small improvement from 6 to 12 months. There was no significant effect of initial trophic versus full feeding for the first 6 days after randomization on survivors' percent predicted for 6-minute-walk distance, cognitive impairment status, and all secondary outcomes.
  
  
  CONCLUSIONS
  EDEN trial survivors performed below predicted values for physical and cognitive performance at 6 and 12 months, with some improvement over time. Initial trophic versus full enteral feeding for the first 6 days after randomization did not affect physical and cognitive performance.
authors.affiliation: Outcomes after Critical Illness and Surgery Group, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA. dale.needham@jhmi.edu
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.forename: Peter E
authors.initials: PE
authors.lastname: Morris
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Amy W
authors.initials: AW
authors.lastname: Wozniak
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.forename: Ramona O
authors.initials: RO
authors.lastname: Hopkins
mesh_terms: D000203:Activities of Daily Living; D055371:Acute Lung Injury / Q000150:complications / Q000628:therapy*; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control; D003422:Critical Care / Q000379:methods; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013997:Time Factors; D016896:Treatment Outcome